血浆置换抢救妊娠导致血栓性血小板减少性紫癜1例
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摘要
目的探讨血浆置换在抢救妊娠导致血栓性血小板减少性紫癜的临床治疗效果。方法使用血浆单采机于患者入院后单采血浆,1次/d,连续3 d,同时补充等量新鲜冰冻血浆和(或)血浆代用品。置换前24 h,置换1次、2次、3次及治疗后24 h、48 h血小板计数、红细胞计数、血红蛋白含量和患者出凝血时间、纤维蛋白原含量。结果完成治疗后,同治疗前进行比较,血小板计数由6×109/L升至70×109/L,红细胞计数由2. 03×1012/L升至2. 83×1012/L,血红蛋白由64g/L升至91g/L,出凝血时间均在正常范围内。结论血浆置换能迅速改善妊娠导致的血栓性血小板减少性紫癜微血管病性溶血性病变,减少血小板聚集性消耗,安全有效。
Objective To investigate the clinical effect of plasma exchange( PE) in thrombotic thrombocytopenic purpura pregnancy.Methods After the case was diagnosed,PE was performed daily,for a total of 3 times. The datas about blood routine examination and hemagglutination in different points were analyzed. Results Clinical symptoms were significantly improved in this patient. The count of Plt were increased from 6×109/L to 70×109/L,as the hemoglobin was increased from 64 g/L to 91 g/L. The change of hemagglutination was acceptable. Conclusion This case illustrates that plasma exchange wasefficacy and safetyinthrombotic thrombocytopenic purpura pregnancy. TPE has significantly decreased assemble of PLT and improved patients' microangiopathic hemolytic anemia caused by pregnancy.
Objective To investigate the clinical effect of plasma exchange( PE) in thrombotic thrombocytopenic purpura pregnancy.Methods After the case was diagnosed,PE was performed daily,for a total of 3 times. The datas about blood routine examination and hemagglutination in different points were analyzed. Results Clinical symptoms were significantly improved in this patient. The count of Plt were increased from 6×109/L to 70×109/L,as the hemoglobin was increased from 64 g/L to 91 g/L. The change of hemagglutination was acceptable. Conclusion This case illustrates that plasma exchange wasefficacy and safetyinthrombotic thrombocytopenic purpura pregnancy. TPE has significantly decreased assemble of PLT and improved patients' microangiopathic hemolytic anemia caused by pregnancy.
引文
[1]曲文杰,徐雪莲.妊娠合并血栓性血小板减少性紫癜的临床分析.医学理论与实践,2016,29(3):362-363.
[2]余文芳,陆元善.血栓性血小板减少性紫癜病案分析—附2例报告.中国输血杂志,2015,28(8):984-985.
[3]张军,顾健.血栓性血小板减少性紫癜发病机制及治疗进展.临床血液学杂志,2016,29(1):73-76.
[4]王友群,俞康,陈阳,等.血浆置换联合激素和免疫抑制剂治疗血栓性血小板减少性紫癜八例临床分析.临床内科杂志,2016,33(2):106-107.
[5] Rogers HJ,Allen C. Thrombotic thrombocytopenic purpura:The role of ADAMTS13.Cleveland Clinic Journal Of Medicine,2016,83(8):597-603.
[6] Zou XL,Wu TJ,Zhang XH. Thrombotic thrombocytopenicnic purpura successfully rescudd by piasma excgange in the ICU:A report of two eases. Expenrimental And Therapentic Medicine,2016,12(1):329-332.
[7] Bendapudi PK,Hurwitz S,Fry A,et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic micoangiopathies:a cohort study. Lancet Haematol,2017Apr,4(4):e157-e164.
[8]严俊,甘东辉,黄金棋.血浆置换联合激素治疗血栓性血小板减少性紫癜疗效研究.中国现代医生,2014,52(35):146-148.
[9]潘玉夏,尚银涛,王兴哲,等.血管性血友病因子裂解蛋白酶活性及抑制物检测在获得性血栓性血小板减少性紫癜中的应用.中国临床医生杂志,2015,43(7):36-38.
[10]张文娟.血管性血友病因子裂解蛋白酶在非血栓性疾病中的研究进展.国际输血及血液学杂志,2014,37(1):78-81.
[11]王天红,程澄,李映桃.妊娠合并血栓性血小板减少性紫癜的研究进展.中国际妇产科学杂志,2014,41(6):1017-1019.
[2]余文芳,陆元善.血栓性血小板减少性紫癜病案分析—附2例报告.中国输血杂志,2015,28(8):984-985.
[3]张军,顾健.血栓性血小板减少性紫癜发病机制及治疗进展.临床血液学杂志,2016,29(1):73-76.
[4]王友群,俞康,陈阳,等.血浆置换联合激素和免疫抑制剂治疗血栓性血小板减少性紫癜八例临床分析.临床内科杂志,2016,33(2):106-107.
[5] Rogers HJ,Allen C. Thrombotic thrombocytopenic purpura:The role of ADAMTS13.Cleveland Clinic Journal Of Medicine,2016,83(8):597-603.
[6] Zou XL,Wu TJ,Zhang XH. Thrombotic thrombocytopenicnic purpura successfully rescudd by piasma excgange in the ICU:A report of two eases. Expenrimental And Therapentic Medicine,2016,12(1):329-332.
[7] Bendapudi PK,Hurwitz S,Fry A,et al. Derivation and external validation of the PLASMIC score for rapid assessment of adults with thrombotic micoangiopathies:a cohort study. Lancet Haematol,2017Apr,4(4):e157-e164.
[8]严俊,甘东辉,黄金棋.血浆置换联合激素治疗血栓性血小板减少性紫癜疗效研究.中国现代医生,2014,52(35):146-148.
[9]潘玉夏,尚银涛,王兴哲,等.血管性血友病因子裂解蛋白酶活性及抑制物检测在获得性血栓性血小板减少性紫癜中的应用.中国临床医生杂志,2015,43(7):36-38.
[10]张文娟.血管性血友病因子裂解蛋白酶在非血栓性疾病中的研究进展.国际输血及血液学杂志,2014,37(1):78-81.
[11]王天红,程澄,李映桃.妊娠合并血栓性血小板减少性紫癜的研究进展.中国际妇产科学杂志,2014,41(6):1017-1019.